So much of this speaks about talking to the OB first. It really, really is vital to talk to your OB before entering the hospital and surprising your hospital staff and OB with your dramatic wishes for your birth. There is nothing more antagonistic than a surprise patient armed with a list of I’m-Not-Gonna’s in labor.

I know that it must be hard in many areas of the country where there aren’t choices – where you have no option BUT to show up with a birth plan that states what you are going to do – that has no approval from an OB because no OB would ever approve of your hair-brained ideas. I can’t imagine how hard that must be. I’ll write a separate version for that group, too. Later, after this version.

Regarding clothes in labor, just don’t change into the gown, that’s all. Don’t put it in the plan. Just don’t change into the gown. No biggie. They may tell you it will get dirty. So what. They may tell you they will have to cut it off in an emergency. So what. Wear what you want.

Bring your own birth ball if you want a birth ball. Bring your own bean bag if you want a bean bag. Even if you are eventually only on the bed, the birth ball and bean bag are great!

Also, the first thing when you walk in the room, ask them to bring in the birth bar. Sometimes they have to search for HOURS for that thing. Ask them to bring it. It is a great device to dangle from, hang on to, squat from… I love using it in the hospital.

(I sprinkle parenthesis throughout... they are thoughts and NOT to be added in the birth plan, but to be considered. Discard them when writing your own, please!)

IF ALL IS WELL: Our Hypnobirthing Birth Plan

We acknowledge that instant decisions must sometimes be made, but the requests made below are for a normal birth. Thank you in advance for all your help in making our birth a joyous experience.

Informed consent – as issues arise – is important to me.

• Our family desires a peaceful and quiet birth environment throughout the labor and birth. Any help you are able to offer is much appreciated.LABOR

• When nurses ask questions required for paperwork, please use positive words and phrases with regards to labor progression and comfort levels.

• Vaginal exams only for clear clinical indications.

(You wouldn’t put this in there, but this would be for decreased fetal heart tones to check for a prolapsed cord, to check for a Malpresentation, to see what is going on if labor has taken a long while, etc. I took out the bullet point that said about ROM – remember, keeping hands out of the vagina is a guarantee that no one will rupture your membranes!)

• I am striving for an unmedicated birth. I know where to obtain anything I could need (from you!) and will ask. Please help me in my wish to remain unmedicated by not offering an epidural or other meds.

(Now that parenthesis up there ^^^^^ [from you] would stay in there)

(With regards to EFM, you will have discussed this with your doctor & hopefully, he has agreed to how I put this. I’ll put it the two most typical ways it is done. The points in the one bullet point are usually broken up into their own points. Blood is ALWAYS taken, so that needs to be removed. When you are in the hospital, the partner can certainly ask that the nurse wait to have it drawn when the mom isn’t having a contraction. That isn’t unreasonable at all… unless things are flying along… in which case, blood might not be being drawn at all! ;)

And that might be the goal – staying home until things are going so quickly a lot of this is moot. But if you are in that mid-point, where things are cranking, but not precipitous, then they might start inbetween contractions and really need to finish while the contraction is going. It isn’t helpful to stop while the contraction is going; it’s just better to hurry up and finish. It doesn’t mean the nurse needs to be painful, though. Or talk loudly. Or anything like that. Just efficient. She doesn’t need to poke around. If she is poking around. She can bloody well stop and wait until the contraction stops!

I know you don’t want either an IV or a lock, but unless your doctor agrees to nothing and you out and out refuse [which you certainly can!] you will have something. I will put in there a great way to say how you will accept something if you choose TO take something. Plus, the lock/IV is put in at the same time as the blood is taken, so it’s kind of confusing that you would separate the two bullet points far away from each other… I am looking at them, trying to put them together here. The IV goes in, the blood is taken, and the lock is capped; that is how it is done. So it isn’t any different of a procedure. Does that make a difference in how you perceive it? And it does need to go before the EFM point, so I will move it up here.)

• Our OB has agreed to saline lock only unless medications are needed.

Or

• Our OB has agreed to defer IV unless he deems it necessary. If you have questions, please ask him.

• Our OB has agreed to 20 minute strips every hour as long as the baby looks great. I will do my part to help create a good 20 minute strip.

(By mentioning at the beginning about the peaceful atmosphere, you have already set the stage that you are eliciting their help to keep it quiet and move slowly throughout the birth, so you don’t need to repeat it throughout. Also, modeling is one of the best ways to get them to do what you want them to do. BPs are done only every 4 hours unless mom has an epidural and can absolutely be done between contractions. The partner or doula can be the go-between regarding when placement of the cuff occurs and once the machine is done with its thing, take the cuff off, even if the nurse isn’t in the room.)

• After an initial 20 minute monitor strip, our OB has agreed to listen to the baby with a Doppler. If there are questions, please ask him.

• Our OB has given permission for light snacks during labor. Any questions can be directed to him.

• My OB has agreed to allow me to change positions throughout second stage, including during the actual birth. I expect to try the toilet, floor, chair and bed.

• My OB has agreed to allow my partner and I to catch our own baby.

• Please do not announce the gender of the baby.

• Please remind our OB that neither my partner nor I want to cut the cord; he has also agreed to wait until it has stopped pulsating before clamping and cutting.

• No pitocin after anterior shoulder! No pitocin after delivery unless warranted!

• Our OB has agreed to allow our placenta to be born naturally and without active management of third stage.

(If you don’t know what that is, please look it up.)

(Nursing a baby is a matter of course nowadays as long as the baby is healthy. Your helper/doula/partner needs to get the baby to the breast. Babies aren’t often jumping out of the womb and to the nipple… some are, but not all, so don’t be discouraged if yours isn’t. You can always do nipple stimulation by hand, too. Or visualization.)

POSTPARTUM

• We would appreciate continuing the quiet and peaceful atmosphere as long as possible.

• We’ve arranged for Oral Vitamin K for the baby; No Erythromycin in the baby’s eyes.

• We refuse the Newborn Screen & will not be circumcising if we have a boy.

We acknowledge that instant decisions must sometimes be made, but the requests made below are for a normal birth.

Informed consent – as issues arise – is important to me.

• Our family desires a peaceful and quiet birth environment throughout the labor and birth. Any help you are able to offer is much appreciated.

LABOR

• When nurses ask questions required for paperwork, please use positive words and phrases with regards to labor progression and comfort levels.

• Vaginal exams only for clear clinical indications.

• I am striving for an unmedicated birth. I know where to obtain anything I could need (from you!) and will ask. Please help me in my wish to remain unmedicated by not offering an epidural or other medications.

• Our OB has agreed to saline lock only unless medications are needed.

Or

• Our OB has agreed to defer IV unless he deems it necessary. If you have questions, please ask him.

• Our OB has agreed to 20 minute strips every hour as long as the baby looks great. I will do my part to help create a good 20 minute strip.

• After an initial 20 minute monitor strip, our OB has agreed to listen to the baby with a Doppler. If there are questions, please ask him.

• Our OB has given permission for light snacks during labor. Any questions can be directed to him.BIRTH

Reader Comments (16)

Hi there.Came across your blog from a friend who passed along the Dr. Wonderful post. I just read this one. I thought I was a well-read mommy (my first just turned a year old) but why should we refuse a newborn screen?

*I* did not with my kids and the overwhelming majority of my clients do not. In fact, I have only had one person in my midst in 25 years refuse. The way I feel about it? Probably. It is something I feel pretty strongly about. Yes, the kid cries. Yes, there is a risk of infection. But, I learned to do the test fast and respectfully to the child and feel the benefits FARRRRRRRRRRRRRRRRR outweigh the risks.

If, however, a client chooses to not test, it becomes a moot point and not another word is said on the subject. I don't harangue. Just offer information and move on.

In that birth plan that I revised, that client was the one that didn't want the Newborn Screen... see a few posts below and the comments attached to that.

Got it. Thanks! We loved the Dr. Wonderful post, btw. It gives us (here on the East Coast) hope. So many of my friends have had to have c-sections, and there are no birthing centers who will take you if you are a VBAC. And so, you have to have either a home birth with a direct entry or deal with the hospital and doctors. My doc was quite cool with my bradley birth plan. Unfort, my baby was breech, a footling as it turned out. So...there is one doc who delivers breech babies here in the D.C. area, but not with a mom who has Gestational Diabetes. Sigh. So, not I get to do a VBAC if I am fortunate to get pregnant again. Good website.

Just a note about the screen and the baby meds. In New York State those things are mandated by law (including vitamin K via injection rather than orally). When parents refuse, the RN is supposed to call Child Protective Services to investigate. In that instance I tend to suggest that they wait 55 minutes of the first hour for bonding without eye goop, then have the baby at the breast for the injection. Just a thought in case others out there reading have run into that situation.

Rachel said... I'm interested in the rationale behind the request not to announce the gender of the child. Could you elaborate? That's one I hadn't thought of before.

That's for the parents to discover. I never announce the sex of the baby, and it sometimes takes a while before the mom/dad even care to look.

NgM, I like this birth plan better. It seems like the universe doesn't hear the "No"s and "Don't"s.The negatives get left out, so if a mom says, "I don't want to be monitored" the universe will only hear, "I want to be monitored". The old,"That which we resist, shall persist" rule. Birth plans should focus on what they DO want, the positives, and not what they DON'T want, the negatives. Negatives are challenging, and send a confrontational message. I like that this birth plan's tone is one of including the nurses and staff and enlisting their assistance, instead of one that is defensive, as if they are expecting the nurses to do cruel and unusual things to them.

There are plenty of parents who would like to find out the gender themselves. They like to unwrap their own present, so to speak. This is an interesting site. I'm a L&D RN who is married to an Army hubby so we move often. I've been in places with midwives and without. I'm currently working in a hospital with close to a 50% section rate and it's making me nuts. I had midwives deliver my two boys in the hospital. I did not use a birth plan because I felt they would not do anything unless it was medically necessary. Does that make sense? They did not routinely give pitocin after delivery, no one had continuous monitoring unless there was something truly wrong,etc. I had a great experience . . .Amy

During a recent conversation with an L&D nurse in my area, she mentioned (rather emphatically) that when any woman comes into her hospital with a birth plan, the nurses automatically start getting the c-section paperwork ready as she is almost guaranteed of one. She cited Murphy's Law as her reasoning. I was horrified! That's not Murphy's Law; that is pure, unadulterated contempt for a mother's choice and a complete and callous disregard for her body and that of her baby.

I was so angry that I barely managed to stay civil until I could get away and RANT and RAVE to my husband. He, too, was horrified, to say the least.

I sincerely hope that other women get better treatment elsewhere, and my heart breaks for all those women who are falling victim to this heartlessness without realizing what they are stepping into as they walk through those doors.

I just want to note that in New York you can opt out of this legal madate for testing if you have religious reasons for refusal. Most states just allow parents to opt out for any reason, but all have to have the religious loophole, since it's a basic principle of federal law, and hard to get around.Here is the actual law:

Twenty minute strips hourly are not evidenced based nor required. iEFM (intermittent EFM) is recommended as follows: If a low risk mom: hourly until active labor, every 30 min in active and every 15 min while pushing. If high risk: every 30 min if not in active labor, every 15 min when active and every 5 min while pushing. Doing hourly strips is simply bc people are unaware of the standards or it's out of fear and it makes them feal better. Also, active labor is now being considered at 6cm. This is huge now when wanting to prevent c-sections bc OBs expect their patients to dilate at least a cm per hour when active. I cringe a bit by some of your suggestions bc you say how important informed consent is but making some of your recommendations w/o informing the person of why something is given is not informing them. Why is Pitocin given after the birth of the placenta? Why is a saline lock helpful to have? For example, if you have a postpartum hemorrage, a mom can exsanguinate in 6-8 minutes. What if she is a hard IV stick? I've seen IVs take 30 min plus if you need other nurses to try and if they are hard to find, you are screwed. I chose saline lock for that purpose and if my baby's heartones were down, I wanted the IV fluid bolus to bring them up. Another thought...the OB cannot okay food or drinking at my hospital. It is established by the hospital itself and the anesthesia dept (even if you don't need an IV, all patients are potential surgical candidates...like prolapsed cord, vasa previa, etc) so no matter what the OB says, food is not okay. Ice chips only and maybe sips of the water that melts. I know there's more that I read. Birth plans suggestions like this set patients up for HUGE disappointment. I suggest meeting with the preadmission nurse as well bc she can explain hospital policies that even an OB can't override like you are suggesting.

Twenty minute strips hourly are not evidenced based nor required. iEFM (intermittent EFM) is recommended as follows: If a low risk mom: hourly until active labor, every 30 min in active and every 15 min while pushing. If high risk: every 30 min if not in active labor, every 15 min when active and every 5 min while pushing. Doing hourly strips is simply bc people are unaware of the standards or it's out of fear and it makes them feal better. Also, active labor is now being considered at 6cm. This is huge now when wanting to prevent c-sections bc OBs expect their patients to dilate at least a cm per hour when active. I cringe a bit by some of your suggestions bc you say how important informed consent is but making some of your recommendations w/o informing the person of why something is given is not informing them. Why is Pitocin given after the birth of the placenta? Why is a saline lock helpful to have? For example, if you have a postpartum hemorrage, a mom can exsanguinate in 6-8 minutes. What if she is a hard IV stick? I've seen IVs take 30 min plus if you need other nurses to try and if they are hard to find, you are screwed. I chose saline lock for that purpose and if my baby's heartones were down, I wanted the IV fluid bolus to bring them up. Another thought...the OB cannot okay food or drinking at my hospital. It is established by the hospital itself and the anesthesia dept (even if you don't need an IV, all patients are potential surgical candidates...like prolapsed cord, vasa previa, etc) so no matter what the OB says, food is not okay. Ice chips only and maybe sips of the water that melts. I know there's more that I read. Birth plans suggestions like this set patients up for HUGE disappointment. I suggest meeting with the preadmission nurse as well bc she can explain hospital policies that even an OB can't override like you are suggesting.